Olpasiran, a small interfering RNA, which blocks lipoprotein(a) (Lp[a]) production, leads to a significant and sustained reduction in oxidized phospholipids (OxPL) on apolipoprotein B (apoB), according to a study published online Feb. 12 in JAMA Cardiology.

Robert S. Rosenson, M.D., from Mount Sinai Hospital in New York City, and colleagues examined the effect of olpasiran on OxPL, high-sensitivity interleukin 6 (hs-IL-6), and high-sensitivity C-reactive protein (hsCRP) in a multicenter, phase 2, dose-finding randomized trial involving 281 patients with atherosclerotic cardiovascular disease and Lp(a) levels >150 nmol/L. Participants were randomly assigned to receive one of four active subcutaneous doses of olpasiran versus placebo: 10 mg every 12 weeks (Q12W); 75 mg Q12W; 225 mg Q12W; or 225 mg every 24 weeks (Q24W).

The researchers found that the placebo-adjusted mean percentage change in OxPL on apoB (OxPL-apoB) concentration from baseline to week 36 was −51.6, −89.7, −92.3, and −93.7 percent for the 10-mg Q12W, 75-mg Q12W, 225-mg Q12W, and 225-mg Q24W doses, respectively, with maintenance of these effects observed to 48 weeks (−50.8, −100.2, −104.7, and −85.8 percent, respectively). For patients treated with olpasiran, there was a strong correlation between percentage reduction in Lp(a) and OxPL-apoB (r = 0.79). No significant impact was seen on hs-CRP or hs-IL-6 for olpasiran versus placebo to weeks 36 or 48.

"Olpasiran leads to a significant reduction in OxPL on apoB," the authors write. "It remains unknown whether these observed effects may offer incremental benefit beyond olpasiran's effect of Lp(a) lowering alone."

Several authors disclosed ties to pharmaceutical companies, including Amgen, which manufactures olpasiran and funded the study.

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Use of secondary cardiovascular disease (CVD) prevention medications has improved little over time, according to a study published in the Feb. 11 issue of the Journal of the American College of Cardiology.

Philip Joseph, M.D., of McMaster University and Hamilton Health Sciences in Ontario, Canada, and colleagues conducted a repeated cross-sectional analysis to examine temporal variations in use of secondary CVD prevention medications across 17 high-, middle-, and low-income countries during a median follow-up of 12 years in the multinational Prospective Urban Rural Epidemiology cohort study.

The researchers found that use of one or more classes of medications for secondary CVD prevention was 41.3 percent at baseline, peaked at 43.1 percent, then decreased to 31.3 percent by the last study visit during the follow-up period. Use decreased from 88.8 to 77.3 percent in high-income countries and increased from 55.0 to 61.1 percent in upper-middle-income countries. Use of at least one class of medications was 29.5 percent at baseline in lower-middle-income countries, peaked at 31.7 percent, and decreased to 13.4 percent; the corresponding use was 20.8, 47.3, and 27.5 percent, respectively, in low-income countries.

"Variations in the use of secondary CVD prevention medications over time in our contemporary cohort study suggest little to no improvement globally and at most economic levels. There continues to be substantial underuse of these medications such that global targets for their use are unlikely to be reached," the authors write.

The study was funded by grants from several pharmaceutical companies.

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Salt substitution is safe and reduces the risk for stroke recurrence and death among patients with stroke, according to a study published online Feb. 5 in JAMA Cardiology.

Xiong Ding, M.P.H., from Wuhan University in China, and colleagues evaluated the effects of salt substitutes versus regular salt on the incidence of recurrent stroke and mortality among patients with stroke. The analysis included 15,249 patients with stroke assigned to a salt substitute (75 percent sodium chloride and 25 percent potassium chloride by mass) or regular salt.

During a median 61.2 months of follow-up, the researchers found that recurrent stroke was significantly lower in the salt substitute group versus regular salt group (rate ratio, 0.86). Even larger effects were seen for hemorrhagic stroke (relative reduction, 30 percent). Additionally, death rates were also significantly lower in the salt substitute group (rate ratio, 0.88), with larger effects on stroke-related deaths (relative reduction, 21 percent). There was no significant difference observed between the groups for hyperkalemia.

"Results of this cluster trial demonstrate that salt substitution was safe, along with reduced risks of stroke recurrence and death, which underscores large health gains from scaling up this low-cost intervention among patients with stroke," the authors write.

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Male patients with inflammatory bowel disease (IBD) face a higher risk for ischemic heart diseases (IHDs), according to a study published in the March issue of the International Journal of Cardiology Cardiovascular Risk and Prevention.

Noa Cohen-Heyman and Gabriel Chodick, Ph.D., both from Tel Aviv University in Israel, investigated the association between IBD and long-term risk for IHD. The analysis included 14,768 patients diagnosed with IBD (from January 1990 to July 2021; 6,144 with ulcerative colitis and 8,624 with Crohn disease) and 120,338 matched individuals without IBD.

The researchers found that during a mean follow-up of 10.5 years, 1.9 percent of participants with IBD and 1.0 percent of the reference group experienced a composite outcome of IHD, myocardial infarction, undergoing percutaneous coronary intervention, or undergoing coronary artery bypass grafting (composite hazard ratio [HR], 1.98). A higher risk for IHD was associated with IBD only in male patients (HR, 1.82), whereas a negative association was seen among female patients (HR, 0.72). When limiting analyses to patients with Crohn disease, patients with ulcerative colitis, patients on steroids, and patients on immunosuppressants, results were similar.

"High-risk individuals could be evaluated for early biomarkers predictive of future IHD, such as high-sensitive cardiac troponin, potentially making them candidates for preventive interventions, including daily aspirin administration," the authors write.

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Trained health care professionals (THCPs), including medical assistants, respiratory therapists, and nurses, with artificial intelligence (AI) assistance can achieve lung ultrasound (LUS) images with diagnostic quality that does not differ significantly from that achieved by experts, according to a study published online Jan. 15 in JAMA Cardiology.

Cristiana Baloescu, M.D., M.P.H., from the Yale University School of Medicine in New Haven, Connecticut, and colleagues examined the ability of AI to guide acquisition of diagnostic-quality LUS images by THCPs in a multicenter diagnostic validation study. Participants aged 21 years or older with shortness of breath recruited from four clinical sites underwent two ultrasound examinations: one by a THCP operator using Lung Guidance AI and one by a trained LUS expert without AI. Before participation, the THCPs underwent standardized AI training for LUS acquisition.

The researchers found that 98.3 percent of THCP-acquired studies were of diagnostic quality, which did not differ significantly from LUS expert-acquired studies (difference, 1.7 percent; 95 percent confidence interval, −1.6 to 5.0 percent).

"THCPs aided by AI achieved comparable performance to expert LUS users in acquiring images meeting diagnostic standards following brief software-focused training," the authors write. "This technology has the potential to extend diagnostic capabilities to underserved areas lacking access to expert personnel."

Several authors disclosed ties to the pharmaceutical and health care industries.

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Polypill treatment for cardiovascular disease prevention is of high value in a low-income, underserved population, according to a study published online Jan. 8 in JAMA Cardiology.

Ciaran N. Kohli-Lynch, Ph.D., from the Feinberg School of Medicine at Northwestern University in Chicago, and colleagues simulated clinical and economic outcomes of the Southern Community Cohort Study (SCCS) Polypill Trial from a health care sector perspective, adopting a time horizon of 10 years. In the base case analysis, polypill treatment was priced at $463 per year. An SCCS Polypill Trial-representative cohort of 100,000 individuals and all trial-eligible non-Hispanic Black adults were analyzed.

The researchers found that polypill treatment was projected to yield a mean of 1,190 additional quality-adjusted life-years (QALYs) compared with usual care in the trial-representative cohort of 100,000 individuals, at a cost of about $10,152,000. The cost of polypill treatment was estimated at $8,560 per QALY gained compared with usual care, and had high value in 99 percent of simulations. Polypill treatment was estimated to be of high value and cost-saving when priced at $559 or less per year and $443 or less per year, respectively. Polypill treatment remained high value in almost all sensitivity analyses. Polypill treatment offered high value in a secondary analysis of 3,602,427 trial-eligible non-Hispanic Black U.S. adults, with an estimated cost of $13,400 per QALY gained.

"In this economic evaluation, using a computer simulation model, we projected that the polypill would be high value in this population if priced based on its component medications ($463 per year) and may reduce income-related health disparities," the authors write.

One author disclosed ties to Boehringer Ingelheim.

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Higher aircraft noise exposure is associated with adverse left ventricular (LV) remodeling, according to a study published online Jan. 8 in the Journal of the American College of Cardiology.

Constantin-Cristian Topriceanu, M.D., from University College London, and colleagues examined the impact of aircraft noise on heart structure and function using data from 3,635 U.K. Biobank participants living near four major U.K. airports who had cardiovascular magnetic resonance (CMR) imaging starting from 2014 and did not report hearing difficulties. The associations between aircraft noise exposure and CMR metrics were examined after adjustment for demographic, socioeconomic, lifestyle, and environmental confounders.

Overall, 3 percent of the participants experienced higher nighttime aircraft noise levels (Lnight) and 8 percent experienced higher weighted 24-hour day-evening-night aircraft noise levels (Lden; ≥45 and ≥50 dB, respectively). The researchers found that participants exposed to higher Lnight had 7 percent greater LV mass, which is associated with a 32 percent greater risk for major adverse cardiac events (MACE), and 4 percent thicker LV walls with a normal septal-to-lateral wall thickness ratio. These individuals also had worse LV myocardial dynamics, including an 8 percent lower global circumferential strain, which is associated with a 27 percent higher MACE risk. The findings were clearest for Lnight but were similar for Lden. Ten to 50 percent of the observed associations were mediated by body mass index and hypertension.

"Our findings also support the negative impacts of aircraft noise on the human heart, with important implications for noise reduction policies," the authors write.

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There is a key time point between midchildhood and adolescence when cardiovascular health (CVH) trajectories begin to decline, according to a study published online Dec. 18 in JAMA Cardiology.

Izzuddin M. Aris, Ph.D., from Harvard Medical School and the Harvard Pilgrim Health Care Institute in Boston, and colleagues characterized CVH trajectories across childhood and adolescence and assessed associations with sociodemographic variables using data from the ongoing prospective prebirth cohort study, Project Viva prebirth cohort. A total of 1,523 live births from 2,218 in the original cohort were included in the analysis.

The researchers found that the mean CVH score was 82.6, 84.1, 82.0, and 73.8 in early childhood, midchildhood, early adolescence, and late adolescence, respectively. The estimated mean age of inflection when the CVH score declined was 10.1 and 10.0 years for male and female children, respectively; the decline in CVH was associated with health behaviors and not health factors. Male versus female children had faster CVH score gain and faster CVH score decline before and after the inflection, respectively (β = 0.79 and −0.33 points/year). Compared with non-Hispanic White children, non-Hispanic Black children and children of other non-Hispanic races had later timing of inflection (β = 0.32 and 0.16 years, respectively).

"Our findings add to the growing body of evidence and provides insight into the natural history and trajectory of CVH in early life," the authors write.

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In a 2024 guidance document issued by the American College of Cardiology and published online Dec. 10 in the Journal of the American College of Cardiology, recommendations are presented for the diagnosis and management of myocarditis.

Mark H. Drazner, M.D., from the University of Texas Southwestern Medical Center in Dallas, and colleagues present an expert consensus decision pathway for diagnosing and managing acute myocarditis in adult patients, reflecting recent advancements in clinical practice.

The authors note that clinicians should be aware of the three classic presentations of myocarditis: chest pain, heart failure/shock, and/or symptoms related to arrhythmia. High-sensitivity cardiac troponin (hs-cTn) is a common diagnostic test for suspected myocarditis, but some patients with myocarditis do not have elevated hs-cTn. Pivotal tests for diagnosis of myocarditis include cardiac magnetic resonance imaging and endomyocardial biopsy. A novel four-stage classification of myocarditis is suggested: Stage A relates to having or being exposed to risk factors; stage B to asymptomatic patients with evidence of myocardial inflammation; stage C to symptomatic myocarditis; and stage D to advanced myocarditis. The trajectories of the four stages need to be defined, including their risk for progression to chronic heart failure. For patients with symptomatic myocarditis, risk stratification guides the decision to refer to an advanced heart failure center with a multidisciplinary team. For myocarditis patients, follow-up does not end after two to three weeks, even if symptoms resolve, but should include two cardiac imaging studies at an early interval after diagnosis and at six months.

"Once a patient is diagnosed, clinicians can then follow the next four steps in the care pathway, including triaging the patient, obtaining pivotal diagnostic tests, providing appropriate therapies, and then longitudinal follow-up," Drazner said in a statement.

Several authors disclosed ties to the pharmaceutical industry.

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Persistent smoking from age 10 through 24 years is associated with increased odds of premature cardiac and structural injury, according to a study published online Dec. 11 in the Journal of the American College of Cardiology.

Andrew O. Agbaje, M.D., M.P.H., Ph.D., from the University of Eastern Finland in Kuopio, examined the longitudinal association of tobacco smoking with structural and functional cardiac injury. A total of 1,931 young adults with complete smoking and echocardiographic measures at age 24 were included.

Agbaje found that at ages 10, 13, 15, 17, and 24 years, the prevalence of smoking was 0.3, 1.6, 13.6, 24, and 26.4 percent, respectively. From 17 to 24 years, there were increases in the prevalence of left ventricular (LV) hypertrophy (from 2.8 to 7.5 percent) and LV diastolic dysfunction (from 10.4 to 16.9 percent). After full adjustment for covariates, persistent smoking from 10 through 24 years was associated with increased LV mass indexed for height (LVMI). In both unadjusted and adjusted models, persistent smoking from childhood was associated with an increase in LVMI from ages 17 to 24 years. Higher odds of LV hypertrophy, high relative wall thickness, LV diastolic dysfunction, and high LV filling pressure at 24 years were seen in association with persistent smoking from childhood through young adulthood in a fully adjusted model (odds ratios, 1.52, 1.38, 1.33, and 1.35, respectively).

"The current findings provide data for policymakers, clinicians, and public health practitioners on crucial timing for preventing smoking and its early consequences in youth," Agbaje writes.

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The annual meeting of the American Heart Association was held this year from Nov. 16 to 18 in Chicago, drawing attendees from around the world, including cardiovascular specialists, surgeons, and nurses as well as other health care professionals. The conference featured presentations focusing on the latest advances in cardiovascular medicine and surgery.

In one study, Lucas X. Marinacci, M.D., of the Beth Israel Deaconess Medical Center in Boston, and colleagues found that cardiovascular mortality increased among rural areas and decreased among urban areas between 2010 and 2022, leading to a widening of rural-urban disparities in cardiovascular death rates.

Pulling information from the U.S. Centers for Disease Control and Prevention WONDER database, national mortality data for more than 11 million adults between 2010 and 2022 were evaluated.

The researchers observed an increase in cardiovascular mortality nationwide after the pandemic, which disproportionately impacted rural areas. In addition, there was notably a concerning rise in cardiovascular mortality among younger (25 to 64 years) rural adults before the pandemic that then accelerated in its wake. Furthermore, differences in poverty, education, and insurance coverage accounted for a substantial portion of rural-urban differences in cardiovascular mortality as of 2022.

"One key takeaway is that targeted policy efforts are needed to address rising cardiovascular mortality in rural areas, especially among younger age groups," Marinacci said. "This can include initiatives to increase insurance coverage, such as by expanding Medicaid under the Affordable Care Act in states that have yet to do so; improving health care access, such as by preventing hospital closures; bolstering the rural health care workforce and expanding telemedicine reimbursement; addressing the surge in severe obesity and its downstream cardiometabolic consequences through concerted public health campaigns; and, finally, addressing the underlying socioeconomic determinants of health -- including educational attainment and poverty -- that are strongly linked to adverse cardiovascular outcomes."

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In another study, M. Ali Sheffeh, M.D., of the Mayo Clinic in Rochester, Minnesota, and colleagues found that patients with a previous stroke who are prescribed either a glucagon-like peptide-1 (GLP-1) receptor agonist or a sodium-glucose cotransporter 2 (SGLT2) inhibitor have a reduced risk for a heart attack, second stroke, and death.

The authors conducted a retrospective study between 2000 and 2022 and included all patients who had a stroke in parts of Minnesota and Wisconsin. The effect of using these two different diabetes medications (SGLT2i and GLP-1 RA) on the risk for death or having a future heart attack or another stroke was then evaluated. The researchers discovered that patients who took one of these medications had a lower risk for death or experiencing a heart attack or another stroke.

"Our findings won't change the current clinical practice; however, they represent an important step toward further evaluating the benefits of these medications in diverse patient populations," Sheffeh said.

One author disclosed financial ties to WizeCare, Novo Nordisk, and Kento Health.

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As part of the ASPirin in Reducing Events in the Elderly (ASPREE) study, Zhen Zhou, Ph.D., of Monash University in Melbourne, Australia, and colleagues found that individuals with more pronounced year-to-year fluctuations in cholesterol levels have an increased risk for cognitive decline.

The investigators evaluated in-trial and posttrial data for participants enrolled in the ASPREE study and found that individuals with greater year-to-year fluctuations in cholesterol levels had a higher risk for developing dementia and cognitive decline. As such, patients with substantial cholesterol fluctuations over years unrelated to medication use may warrant closer monitoring of dementia risk and other health conditions associated with increased dementia risk. In contrast, no correlation was observed between average blood cholesterol levels over the lipid measurement period and subsequent dementia risk.

"These findings underscore the importance of monitoring cholesterol level variation as a potential predictor of dementia risk, rather than solely relying on a one-off cholesterol measurement," Zhou said.

Several authors disclosed financial ties to the pharmaceutical and medical device industries.

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AHA: Variation Seen in Rates of SGLT2i Rx for Heart Failure, LVEF >40 Percent

TUESDAY, Nov. 26, 2024 (HealthDay News) -- From 2021 to 2023, there was an increase in prescription rates of a sodium-glucose cotransporter-2 inhibitor for patients with heart failure and a left ventricular ejection fraction greater than 40 percent, according to a study published online Nov. 18 in JAMA Cardiology to coincide with the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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AHA: Bumetanide Nasal Spray Statistically Bioequivalent to Oral Bumetanide

MONDAY, Nov. 25, 2024 (HealthDay News) -- Bumetanide nasal spray has statistical bioequivalence to oral bumetanide, according to a research letter published online Nov. 18 in Circulation to coincide with the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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AHA: Muvalaplin Reduces Lipoprotein(a) Levels in Individuals With Cardiovascular Risk

MONDAY, Nov. 25, 2024 (HealthDay News) -- Muvalaplin reduces lipoprotein(a) levels, according to a study published online Nov. 20 in the Journal of the American Medical Association to coincide with the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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AHA: Initial Catheter Ablation Beneficial for Ventricular Tachycardia

FRIDAY, Nov. 22, 2024 (HealthDay News) -- An initial strategy of catheter ablation leads to a lower risk for a composite primary end point than antiarrhythmic drug therapy among patients with ischemic cardiomyopathy and ventricular tachycardia, according to a study published online Nov. 16 in the New England Journal of Medicine to coincide with the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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AHA: Tirzepatide Beneficial for Heart Failure With Preserved EF, Obesity

FRIDAY, Nov. 22, 2024 (HealthDay News) -- For patients with heart failure with preserved ejection fraction, tirzepatide yields a reduced risk for a composite of death from cardiovascular causes or worsening heart failure, according to a study published online Nov. 16 in the New England Journal of Medicine to coincide with the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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AHA: Half of U.S. Adults Are Eligible for Treatment With Semaglutide

FRIDAY, Nov. 22, 2024 (HealthDay News) -- More than half of all U.S. adults are eligible for semaglutide therapy, according to a research letter published online Nov. 18 in JAMA Cardiology to coincide with the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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AHA: Intensive Strategy for Lowering Systolic BP Beneficial in Type 2 Diabetes

WEDNESDAY, Nov. 20, 2024 (HealthDay News) -- For patients with type 2 diabetes and elevated systolic blood pressure, an intensive-treatment strategy is better than a standard-treatment strategy for incidence of major cardiovascular disease events, according to a study published online Nov. 16 in the New England Journal of Medicine to coincide with the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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AHA: Rising Outdoor Temperatures Tied to Higher Risk for Atrial Fibrillation

MONDAY, Nov. 18, 2024 (HealthDay News) -- There is a dose-response relationship between rising outdoor temperatures and increased atrial fibrillation events, according to a study presented at the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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AHA: AI Analysis of Images, Videos Can ID Early Hypertension, Diabetes

MONDAY, Nov. 18, 2024 (HealthDay News) -- Machine learning analysis of photo and video data demonstrates a promising way to noninvasively detect early hypertension and diabetes, according to a study presented at the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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AHA: Rural-Urban Disparities Persist in Cardiovascular Mortality

FRIDAY, Nov. 15, 2024 (HealthDay News) -- Between 2010 and 2022, cardiovascular mortality increased in rural areas and decreased in urban areas, according to a study scheduled for presentation at the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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AHA: More Moderate-to-Vigorous Exercise Tied to Lower Risk for A-Fib

THURSDAY, Nov. 14, 2024 (HealthDay News) -- Higher amounts of moderate-to-vigorous physical activity are inversely associated with a lower risk for incident atrial fibrillation, according to a study scheduled for presentation at the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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AHA: Obesity-Linked Ischemic Heart Disease Mortality Increasing in U.S.

WEDNESDAY, Nov. 13, 2024 (HealthDay News) -- In the United States, obesity-related ischemic heart disease mortality is increasing, with the highest rates seen among men, Blacks, and those in the Midwest, according to a study presented at the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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AHA: GLP-1 RA, SGLT-2i Use Can Lower Risk for MI, Recurrent Stroke in Stroke Survivors

TUESDAY, Nov. 12, 2024 (HealthDay News) -- For patients with ischemic stroke, sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists are associated with reduced mortality, myocardial infarction, and recurrent stroke, according to a study presented at the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

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From 2021 to 2023, there was an increase in prescription rates of a sodium-glucose cotransporter-2 inhibitor (SGLT2i) for patients with heart failure and a left ventricular ejection fraction (LVEF) greater than 40 percent, according to a study published online Nov. 18 in JAMA Cardiology to coincide with the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

Mohammad Abdel Jawad, M.D., from the University of Missouri Kansas City Healthcare Institute for Innovations in Quality, and colleagues examined trends and hospital-level variation in SGLT2i adoption in a cohort study involving patients with LVEF >40 percent who were hospitalized for decompensated heart failure.

The researchers found that 13.9 percent of 158,849 eligible patients with heart failure and an LVEF >40 percent were prescribed an SGLT2i at hospital discharge. There was an increase in quarterly prescription rates from 4.2 percent in July to September 2021 to 23.5 percent in July to September 2023. Patients with heart failure with mildly reduced LVEF (41 to 49 percent) were more likely to have an SGLT2i prescription than those with preserved LVEF (≥50 percent; 18.5 versus 13.0 percent). There was high variance observed between hospitals in the rate of SGLT2i prescription after adjustment for patient characteristics (median odds ratio, 2.12). Among 518 hospitals with 10 or more eligible discharges, 2.1 and 44.8 percent discharged ≥50 percent and fewer than 10 percent of eligible patients with an SGLT2i prescription, respectively.

"This variation highlights the need to understand the strategies used by higher prescribing centers to increase SGLT2i adoption," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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From 2021 to 2023, there was an increase in prescription rates of a sodium-glucose cotransporter-2 inhibitor (SGLT2i) for patients with heart failure and a left ventricular ejection fraction (LVEF) greater than 40 percent, according to a study published online Nov. 18 in JAMA Cardiology to coincide with the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

Mohammad Abdel Jawad, M.D., from the University of Missouri Kansas City's Healthcare Institute for Innovations in Quality, and colleagues examined trends and hospital-level variation in SGLT2i adoption in a cohort study involving patients with LVEF greater than 40 percent who were hospitalized for decompensated heart failure.

The researchers found that 13.9 percent of 158,849 eligible patients with heart failure and an LVEF greater than 40 percent were prescribed an SGLT2i at hospital discharge. There was an increase in quarterly prescription rates from 4.2 percent in July to September 2021 to 23.5 percent in July to September 2023. Patients with heart failure with mildly reduced LVEF (41 to 49 percent) were more likely to have an SGLT2i prescription than those with preserved LVEF (≥50 percent) (18.5 versus 13.0 percent). There was high variance observed between hospitals in the rate of SGLT2i prescription after adjustment for patient characteristics (median odds ratio, 2.12). Among 518 hospitals with 10 or more eligible discharges, 2.1 and 44.8 percent discharged ≥50 percent and fewer than 10 percent of eligible patients with an SGLT2i prescription, respectively.

"This variation highlights the need to understand the strategies used by higher prescribing centers to increase SGLT2i adoption," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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Heart failure with preserved ejection fraction (HFpEF) is underdiagnosed in patients with severe secondary tricuspid regurgitation (STR) of undefined etiology (isolated STR), according to a study published online Nov. 6 in JAMA Cardiology.

Jwan A. Naser, M.B.B.S., from the Mayo Clinic in Rochester, Minnesota, and colleagues examined the prevalence of HFpEF and precapillary pulmonary hypertension (PH) in patients with severe isolated STR referred for exercise right heart catheterization (RHC) in a cross-sectional study. Fifty-four consecutive patients with severe isolated STR who underwent rest-and-exercise RHC were included.

The primary indication for RHC was evaluation of tricuspid regurgitation prior to potential intervention, evaluation of PH, and confirmation of HFpEF in 67, 24, and 9 percent of patients, respectively. The researchers identified HFpEF in 74 percent of patients; in only 35 percent of patients was HFpEF recognized prior to RHC. Precapillary PH was diagnosed in 10 of the 14 remaining patients without HFpEF (71 percent). Twenty-four patients (60 percent) who were subsequently diagnosed with HFpEF did not have guideline-defined diastolic dysfunction. Robust discrimination for HFpEF was seen for left atrial emptying fraction and strain (area under the receiver operating characteristic curve, 0.90 and 0.91, respectively).

"HFpEF remains underdiagnosed," the authors write. "Patients with severe STR in the absence of another apparent etiology should be evaluated for HFpEF and precapillary PH."

Two authors disclosed ties to the biopharmaceutical and medical device industries.

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More than half of all U.S. adults are eligible for semaglutide therapy, according to a research letter published online Nov. 18 in JAMA Cardiology to coincide with the American Heart Association Scientific Sessions 2024, held from Nov. 16 to 18 in Chicago.

Ivy Shi, M.D., from the Beth Israel Deaconess Medical Center in Boston, and colleagues used data from 25,531 participants in the National Health and Nutrition Examination Survey (2015 to March 2020) to quantify the number of U.S. adults eligible for semaglutide. Eligibility criteria included: (1) diabetes; (2) weight management (body mass index [BMI] ≥30 kg/m2 or BMI ≥27 kg/m2 with a weight-related comorbidity [hypertension, hyperlipidemia, or history of myocardial infarction or stroke]); and (3) secondary prevention of cardiovascular disease (CVD; aged 45 years or older, BMI ≥27 kg/m2, and a history of myocardial infarction or stroke).

The researchers found that semaglutide was indicated for an estimated 35.0 million adults for diabetes management, 129.2 million adults for weight management, and 8.9 million adults for secondary prevention of CVD. Of the 39.3 million U.S. adults eligible for semaglutide for diabetes or secondary prevention of CVD, 13.0 million were insured by Medicare and 4.7 million were insured by Medicaid.

"Efforts to increase equitable uptake should be coupled with strategies to ensure that the cost of semaglutide is commensurate with the value of the health benefits it produces," the authors write.

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For patients with symptomatic and severe tricuspid regurgitation (TR), tricuspid transcatheter edge-to-edge repair (T-TEER) yields significant improvements in primary end points, according to a study published online Oct. 27 in the Journal of the American College of Cardiology to coincide with the annual Transcatheter Cardiovascular Therapeutics conference, held from Oct. 27 to 30 in Washington, D.C.

Gilbert H.L. Tang, M.D., from the Mount Sinai Medical System in New York City, and colleagues examined outcomes from the randomized cohort of the TRILUMINATE Pivotal trial to assess the impact of TR reduction with T-TEER with the TriClip device. A total of 572 individuals with symptomatic, severe TR were randomly assigned (350 in the primary cohort; 222 in subsequent enrollment).

The researchers found that the primary end point (hierarchical composite of all-cause mortality or tricuspid valve surgery, heart failure hospitalizations [HFH], and quality-of-life improvement measured by the Kansas City Cardiomyopathy Questionnaire [KCCQ] at one year) was met for the full cohort, with a win ratio of 1.84. For the device and control groups, freedom from all-cause mortality and tricuspid valve surgery through 12 months was 90.6 and 89.9 percent, respectively. The annualized HFH rate was comparable between the groups (0.17 versus 0.20 events/patient-year for device versus control individuals). Overall, 49.5 percent of device individuals and 25.6 percent of control individuals achieved a ≥15-point KCCQ score improvement, indicating a significant treatment effect for quality of life. In addition, all secondary end points favored T-TEER.

"Changes in quality of life were associated with the degree of residual TR and the magnitude of TR reduction at one year," the authors write.

The study was funded by Abbott Vascular, the manufacturer of the TriClip device.

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For patients with symptomatic and severe or greater tricuspid regurgitation (TR), transcatheter tricuspid valve replacement (TTVR) plus optimal medical therapy (OMT) yields substantial improvement in symptoms, function, and quality of life, according to a study published online Oct. 30 in the Journal of the American College of Cardiology. The research was published to coincide with the annual Transcatheter Cardiovascular Therapeutics conference, held from Oct. 27 to 30 in Washington, D.C.

Suzanne V. Arnold, M.D., from the Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, and colleagues performed an in-depth analysis of the health status of patients enrolled in the TRISCEND II pivotal trial. Patients with symptomatic and severe or greater TR were randomly assigned to TTVR with the EVOQUE tricuspid valve replacement system plus OMT or OMT alone (259 and 133 patients, respectively).

The researchers found that at each follow-up time point, significantly greater improvement in both disease-specific and general health status was seen for patients receiving TTVR + OMT. At each time point, the mean between-group differences in the Kansas City Cardiomyopathy Questionnaire Overall Summary Score favored TTVR + OMT: 11.8, 20.8, and 17.8 points at 30 days, six months, and one year, respectively. Health status was improved by TTVR + OMT to a greater extent among patients with torrential or massive TR versus severe TR. At one year, 64.6 and 31.0 percent of those receiving TTVR + OMT and OMT alone, respectively, were alive and well.

"Further study is warranted to understand the long-term durability of these benefits as well as to identify the optimal patient population for this novel therapy," the authors write.

The study was funded by Edwards Lifesciences, the manufacturer of the EVOQUE tricuspid valve replacement system.

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For individuals with heart failure with reduced ejection fraction (HFrEF), substantial mortality benefits would result from optimal use of guideline-directed medical therapy (GDMT), according to a study published online Oct. 2 in JAMA Cardiology.

Amber B. Tang, M.D., from the University of California Los Angeles, and colleagues examined the projected population-level benefit of optimal GDMT use globally among patients with HFrEF based on data derived from previously published studies.

Overall, 8,235,063 of an estimated 28.89 million people worldwide with HFrEF were potentially eligible for but not receiving β-blockers; 20,387,000 were eligible for but not receiving angiotensin receptor-neprilysin inhibitors; 12,223,700 were eligible for but not receiving mineralocorticoid receptor antagonists; and 21,229,170 were eligible for but not receiving sodium glucose cotransporter-2 inhibitors. The researchers found that 1,188,277 deaths could potentially be prevented over 12 months with optimal implementation of quadruple GDMT. Many of these deaths were projected in Southeast Asia, Eastern Mediterranean and Africa, and the Western Pacific regions.

"Although future studies are needed to better understand the heterogeneity that exists within each region and potential interventions targeted to different settings, these findings demonstrate the urgent need for improved implementation of GDMT therapies worldwide," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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